Hearing impairment prevention in developing countries: making things happen

doi:10.1016/S0165-5876(00)00392-X

International Journal of Pediatric Otorhinolaryngology

Volume 55, Issue 3, 16 October 2000, Pages 167-171

https://doi.org/10.1016/S0165-5876(00)00392-X Get rights and content

Abstract

It is estimated that at least two thirds of the world's population of persons with disabling hearing impairment reside in developing countries. Yet, little and slow progress have been reported in these countries towards tackling this problem principally on account of inadequate resources. The prospects for inprovement remain uncertain. This paper re-examines the peculiar nature of hearing impairment prevention within the context of the existing health-care needs of most of these nations. It establishes that the failure to recognize the dynamics of the social change that underlie an effective national programme on hearing impairment prevention may, in itself, forestall a successful and sustainable outcome even when more resources become available.

Introduction

Many developing countries are confronted with the challenge of an overwhelming burden of infectious and deadly diseases. Thus, it is not uncommon to find that health-care needs in most of these countries are ranked into high and low priorities.

Life-threatening conditions and diseases such as diphtheria, tetanus and meningococcal meningitis naturally engage the keenest attention of healthcare managers. In contrast, other conditions perceived as non-life threatening such as hearing impairment and deafness are generally neglected. This action is often justified on the basis of the limited resources available to most governments in developing countries from own revenue, grants and donations by international agencies. Current statistics in fact, indicate a global decline in grants and donations from the rich nations of the world to developing countries [1].

The adverse impact of hearing impairment on the acquisition of linguistic skills in children and psycho-social conditions in adults are well established. It is also known that hearing impairment places severe limitations on educational and economic pursuits essential to achieving a good quality of life. Hearing loss in majority of cases is irreversible, while the cost of rehabilitation is not readily affordable.

Given this scenario, how can we engineer a change in response and action towards its prevention and management as widely advocated? This paper discusses a change-process mechanism that could assist programme coordinators at all levels in optimizing the limited opportunities and resources available for this task.

Section snippets

Global and regional initiatives

The World Health Organisation (WHO) in its Alma-Ata Declaration at the 32nd World Health Assembly (WHA) [2] reaffirmed that health is not simply the absence of disease or infirmity but a state of complete physical, mental and social well-being. It recognized the provision of health at the highest possible level as a necessary social goal by all governments and health authorities. This declaration was adopted in 1981 thereby changing the focus of WHO from disease management to total well-being.

Prevention programme as a social change

Typically, when the programme content has been agreed the next stage involves determining what strategies would be followed to implement the programme. Thereafter, the deployment of manpower and material resources comes into focus. However, the provision of requisite human and material resources is too often regarded as the only critical success factor at this stage. This unfortunately, overlooks the nature and process of the social change, which underlies the programme. It is, therefore, not

Evaluating the change players

The various parties and workers enlisted into the task of hearing impairment prevention and management can be classified into four main groups as illustrated in the figure below:

For clarity, the knowledge of change content in our context is defined as the knowledge and appreciation of the significance of hearing disability, its prevalence, the value of its prevention, early detection and effective management.

Readiness for change is determined by the extent of the action or interest demonstrated

Mobilizing the change agents

In practice limited choice may exist in securing the right calibre of workers for the programme. However, it is necessary that any categories A, B, or C workers currently or likely to be engaged are rapidly assisted to become change agents.

For instance those in group A would require training to acquire new skills and counselling on the benefits of the programme. It is not unlikely that the acquisition of the requisite knowledge of the proposed programme may in itself stimulate a readiness for

Implementing the change programme

It is evident from the foregoing that any attempt by governments, health authorities or funding agencies to deploy resources to the various workers involved in prevention programmes on hearing impairment without regard to their status or disposition to the required change may be counter-productive. The knowledge of the change programme and readiness or commitment to the programme cannot be presumed. It must be carefully evaluated. The mobilization of change agents and their empowerment through

Conclusion

Many developing countries are not short of plans and programmes. The perennial hurdle has always been how to achieve reasonable balance in priorities in the face of competing needs and limited resources. Hearing impairment presents an additional and unique challenge by its very nature as an invisible handicap that is non-life threatening. Therefore, any attempt by these countries to promote an effective prevention programme must approach this task as a social change in which economic resources

Acknowledgements

The author wishes to acknowledge the contributions of Prof. Paul Strebel on the subject of change management.

References (8)

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Prevention of hearing impairment, Resolution of the 48th World Health Assembly, 12 May 1995, WHA...
Report of the Working Group on Prevention of Hearing Impairment and Deafness, World Health Organisation Western Pacific...

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Special reportHearing impairment prevention in developing countries: making things happen